2023 GEHA Dental Plans
Choose from two comprehensive dental plans with a large, nationwide network and worldwide coverage.
geha.com | 877.590.4342
What’s inside
03 Welcome 04 Choose from two dental plans 04 High 04 Standard 05 What’s new in 2023 06 In-network preventive care covered 100% 07 Compare GEHA dental plans 08 Coverage for major dental needs 10 Vision discounts included with both dental plans 11 Included benefits & discounts 12 Step 1: Use your ZIP code to find your rate code 13 Step 2: Use your rate code to find your 2023 premium 14 Definitions 15 Helpful resources
02
2023 GEHA dental plans
Welcome
Whatever stage of life you are in and whatever your needs, GEHA has a plan for you.
We believe dental care isn’t one size fits all, and our plans are designed with that in mind. For more than 85 years, GEHA (Government Employees Health Association, Inc.) has provided benefit plans designed exclusively for federal employees.
GEHA offers two dental plan options:
Open Season begins on Monday, November 14, and concludes on Monday, December 12. NOV DEC
High
Standard
Both plans include: • Comprehensive dental services, from preventive care to crowns, bridges and dentures • No in-network deductibles and no waiting periods, including orthondontia for children and adults • Worldwide coverage with a large nationwide network. Search our network at geha.com/Find-Care
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2023 GEHA dental plans
Choose from two dental plans
High
Get plan details at geha.com/HighDental
Who should consider High dental? • People planning for dental procedures in the near future • Adults and children who want a lower out-of-pocket cost for orthodontic coverage • People with medical conditions that may affect or can be affected by their dental health • People looking for the peace of mind that comes with comprehensive coverage
About this plan: • Includes three dental cleanings per year • Includes an unlimited annual maximum benefit per person • Provides GEHA’s greatest coverage for intermediate and major dental care services • Offers orthodontic coverage for both children and adults, with no waiting period
How often you use your plan:
Low
Average
High
Standard
Get plan details at geha.com/StandardDental
Who should consider Standard dental? • People concerned with their overall health and wellness • People looking for the peace of mind that comes with additional dental coverage beyond what’s included in their medical plan
About this plan: • GEHA’s lowest premium dental plan • Offers orthodontic coverage for both children and adults, with no waiting period • Includes an in-network annual maximum of $2,500 per person
How often you use your plan:
Low
Average
High
This is a brief description of services covered under the GEHA Connection Dental Federal plan. For a complete list of plan limitations and exclusions, please refer to the GEHA Connection Dental Federal plan brochure available online at geha.com/PlanBrochureDental
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2023 GEHA dental plans
What’s new in 2023
• The Standard dental plan no longer has an orthodontia waiting period for children or adults. • The High plan now offers three dental cleanings per year
Is your provider in-network? Visit geha.com/Find-Care to search our network of more than 400,000 provider locations nationwide.
Need help understanding insurance terms? See page 14 for helpful definitions.
Ready to enroll? Visit benefeds.com and follow the prompts to enroll in GEHA Connection Dental Federal. Or call BENEFEDS toll-free at 877.888.3337 TTY: 877.889.5680
For a complete list of plan changes, download the plan brochure at geha.com/PlanBrochureDental
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2023 GEHA dental plans
In-network preventive care covered 100% GEHA’s dental plans offer over 400,000 in-network provider locations nationwide as well as worldwide coverage. Use in-network providers to get the greatest value from your GEHA dental plan. In-network preventive care is covered at 100% . For all other dental services, in-network providers will not bill you more than the agreed-upon fees for covered services.
To find a provider, or to see if your provider is in-network, visit geha.com/Find-Care
Term
Definition
If your out-of-network dentist charges more than GEHA’s agreed-upon fee (plan allowance) for a specific service, you are responsible for the difference between the plan allowance and the out-of-network dentist’s charge plus regular coinsurance. If you have a FEHB medical plan with dental coverage, your medical plan will be considered the primary payer for some services before any benefits are paid by your FEDVIP dental plan.
Out-of-network services
FEHB medical plans
Prior orthodontic services
GEHA does not cover cosmetic treatment or orthodontic work in progress (except for orthodontics started under TRICARE).
This is a brief description of services covered under the GEHA Connection Dental Federal plan. For a complete list of plan limitations and exclusions, please refer to the GEHA Connection Dental Federal plan brochure available online at geha.com/PlanBrochureDental
Did you know? GEHA plans include vision benefits. For more details, see page 10 .
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2023 GEHA dental plans
Compare GEHA dental plans
No in-network deductibles and no waiting periods. Compare plans at geha.com/CompareDental
High Dental in-network or out-of-network 1 you pay
Standard Dental in-network you pay
Standard Dental out-of-network 1 you pay
2023 dental benefit
Benefit description
Class A. Covers two exams, two cleanings, and two 2 sets of bitewing X-rays per calendar year
Nothing
Nothing
25%
Basic
Class A. Covers a third cleaning
Nothing
Basic
No benefit
No benefit
Class A. One oral evaluation per patient in a 12-consecutive-month period Class B. Covers restorations, extractions and periodontal maintenance Class C. Covers root canals, crowns, bridges, dentures and periodontal surgery 3 Class D. Covers adults and children orthodontic. No waiting periods.
Teledentistry.com
Nothing
Nothing
No benefit
20%
45%
50%
Intermediate
50%
65%
70%
Major
30% with $3,500 lifetime maximum
50% with $2,500 lifetime maximum
50% with $1,500 lifetime maximum
Orthodontic
Class A, B and C services only
Unlimited per person
$2,500 per person
$2,000 per person
Calendar year maximum
Class B and C services out-of-network deductible is $0 for High, $25 Standard Self Only, $50 Standard Self Plus One and $75 Standard Self and Family. 1 If your out-of-network dentist charges more than GEHA’s agreed-upon plan allowance for a specific service, you are responsible for the difference between the plan allowance and the out-of-network dentist’s charge plus regular coinsurance. 2 Two bitewings covered annually for members 22 and under. One set of bitewings is covered per year for adults ages 23+. 3 Implants are limited to $2,500 per person per year in-network or out-of-network on High. For Standard, implants are limited to $2,500 per person per year in-network, or $2,000 per person per year out-of-network.
This is a brief description of services covered under the GEHA Connection Dental Federal plan. For a complete list of plan limitations and exclusions, please refer to the GEHA Connection Dental Federal plan brochure available online at geha.com/PlanBrochureDental
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2023 GEHA dental plans
Coverage for major dental needs You pay $0 deductible in-network. No waiting periods. GEHA’s plans let you start treatments right away, even when your needs go beyond annual cleanings. Examples of three common major dental services
Orthodontic coverage
Dental implant coverage
Night guard 1 coverage
Coverage type
In-network for High and Standard
You pay your regular coinsurance and/ or any amount that exceeds the lifetime benefit maximum. You pay any charges that exceed the plan allowance, plus any regular coinsurance. You pay any charges that exceed the plan allowance, plus any regular coinsurance.
You pay your regular coinsurance and/ or any amount that exceeds the annual benefit maximum. You pay any charges that exceed the plan allowance, plus any regular coinsurance. You pay the $25 deductible plus any charges that exceed the plan allowance, plus any regular coinsurance. GEHA pays a $2,500 calendar year maximum, per covered member. GEHA pays a $2,500 in-network, $2,000 out-of-network,
You pay your regular coinsurance and/ or any amount that exceeds the annual benefit maximum. You pay any charges that exceed the plan allowance, plus any regular coinsurance. You pay the $25 deductible plus any charges that exceed the plan allowance, plus any regular coinsurance.
High out-of-network
Standard out-of-network
High maximum benefit
GEHA pays a $3,500 lifetime maximum, per covered member.
GEHA pays once per calendar year.
Standard maximum benefit
GEHA pays a $2,500 in-network, $1,500 out-of-network, lifetime maximum, per covered member.
GEHA pays once per calendar year.
calendar year maximum, per covered member.
1 Also known as occlusal guard. This is a brief description of services covered under the GEHA Connection Dental Federal plan. For a complete list of plan limitations and exclusions, please refer to the GEHA Connection Dental Federal plan brochure available online at geha.com/PlanBrochureDental
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2023 GEHA dental plans
geha.com | 877.590.4342
Coverage details for three common major dental services
Orthodontic coverage
Dental implant coverage
Night guard 1 coverage
Coverage detail
Age limit for both dental plans
Members age 13 or older
None
None
Waiting period
None
None
None
Services not covered
Cosmetic treatment or orthodontic work in progress is not covered (except for members with orthodontics that started under TRICARE).
Any service associated with implants not
Guards used to treat temporomandibular joint dysfunction (TMJ) are not covered.
specifically listed in the plan brochure is not covered.
1 Also known as occlusal guard. This is a brief description of services covered under the GEHA Connection Dental Federal plan. For a complete list of plan limitations and exclusions, please refer to the GEHA Connection Dental Federal plan brochure available online at geha.com/PlanBrochureDental
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2023 GEHA dental plans
Vision discounts included with both dental plans
With GEHA dental plans, you get discounts on eye exams, frames, and lenses through EyeMed. ® There is no limit on the number of discounted glasses or conventional contacts you may purchase each year. The EyeMed network includes Independent Provider Network, LensCrafters, Pearle Vision, Target Optical, contactsdirect.com , glasses.com and more. Members also save on LASIK at participating US Laser Network locations.
Learn more at geha.com/Vision Examples of common vision services and what you will pay at an EyeMed network location: Vision services in-network You pay Routine annual eye exams $5 Eyeglass lens: UV treatment Eyeglass lens: Tint (solid and gradient) Eyeglass lens: Standard plastic scratch coating $15
$40
Eyeglass lens: Standard polycarbonate
$45
Eyeglass lens: Standard anti-reflective coating
Up to $50
Eyeglass lenses (pair) standard plastic single vision
Up to $70
Eyeglass lenses (pair) standard plastic bifocal
Up to $105
Eyeglass lenses (pair) standard plastic trifocals
Up to $135
Eyeglass lenses (pair) standard progressive lens
60% of retail price
Frames
80% of retail price
Eyeglass lens: Photochromatic/transitions plastic
85% of retail price
Conventional contact lenses
Disposable contact lenses
Not covered
Out-of-network , the plan will reimburse $45 per covered member, per year, for routine annual eye exams. No out-of-network coverage for other services. These benefits are neither offered nor guaranteed under contract with the FEDVIP program, but are made available to all Enrollees who become members of GEHA and their eligible family members.
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2023 GEHA dental plans
Included benefits & discounts
Electric toothbrush discount 1,2 Enjoy 70% off a cariPRO ® premium electric toothbrush. geha.com/Toothbrush
Teeth whitening discounts 1 Get a 20% discount on the lowest published price on all Smile Brilliant ® home teeth whitening and oral care products. geha.com/Whitening
Hearing aid discounts 1 Get discounts through TruHearing ® on hearing aids. Save up to 30% to 60% off hearing aids. Some average more than $2,600 in savings per pair. geha.com/Hearing
Medical alert system discount 1 Get free activation on Life Alert ® services, plus a 10% monthly discount, for you and your extended family. geha.com/LifeAlert
1 These benefits are neither offered nor guaranteed under contract with the FEDVIP program, but are made available to all Enrollees who become members of GEHA and their eligible family members. 2 The cariPRO ® premium toothbrush removes seven times more plaque than a regular brush, is completely waterproof and comes with a two-year manufacturer’s warranty. Replacement brush heads with high-quality DuPont TM bristles are also available at this exclusive, member-only price.
This is a brief description of the features of the GEHA Connection Dental Federal Plan. Before making a final decision, please read the Plan’s Federal brochure, available at geha.com/PlanBrochureDental
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2023 GEHA dental plans
Step 1: Use your ZIP code to find your rate code Find your state and the first three digits of your ZIP in the chart below to determine your rate code. Use that code on the next page to determine your 2023 dental premium. geha.com/DentalRates
First 3 digits of ZIP code
Rate code
First 3 digits of ZIP code
Rate code
First 3 digits of ZIP code
Rate code
State
State
State
AL, AR, GU, IA, MS, ND, NE, PR, VI ID, LA, MO, MT, NC, OK, SC, SD, TN, UT, VT DE, HI, NM, OR CO, DC, NH, RI
NY
Rest of state
2
IN
Rest of state 1
Entire state or territory
430-433, 437, 440-443, 446, 447, 450-455, 459
1
KS
660-662, 666
2
OH
2
KS
Rest of state 1
KY
410
2
OH Rest of state
1
Entire state
2
KY
Rest of state 1
PA
172-174
4
MA 012
2
PA
180-181, 183
5
Entire state or territory
MA
Rest of state 4
PA
189-196
3
3
205-212, 214, 216, 217
PA Rest of state
1
MD
4
Entire state
4
755-759, 763- 769, 776-779, 783-785, 788- 799, 885 733, 786-787
MD 219
3
AK AZ AZ
Entire state
5 3
TX
1
850-853, 864
MD
Rest of state 2
Rest of state 2
TX
3
ME
039-042
4
900-931, 933- 935, 939-952, 954, 956-959
TX
Rest of state
2
CA
5
ME
Rest of state 3
201, 203, 205, 220-227
VA
4
MI
480-485
3
CA CT CT
Rest of state 4
MI
Rest of state 2
VA Rest of state
2
064-069
5
MN 3 MN Rest of state 2 NJ 080-084 3 NJ Rest of state 5 NV 897 5 NV Rest of state 3 550-555, 563
Rest of state 4
WA 980-985
5
FL FL
329-334, 349
3
WA
986
3
Rest of state 2
WA Rest of state
4
300-303, 305, 306, 311, 399
GA
3
WI
540
3
GA
Rest of state 2
WI
Rest of state
2
IL IL IL
600-609, 613
3 2
WV 254
4
620, 622
WV Rest of state
1
005, 100- 119,124-126
NY
5
Rest of state 1
WY
834
2
460-462, 470, 472, 473
NY
063
4
IN
2
WY
Rest of state
1
127, 129-139, 144-149
NY
1
IN
463,464
3
INTL All international
5
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2023 GEHA dental plans
Step 2: Use your rate code to find your 2023 premium
geha.com/DentalRates
Employed – biweekly High premium
Rate code 1 1
Rate code 2 1
Rate code 3 1
Rate code 4 1
Rate code 5 1
$17.25
$19.40
$21.21
$23.70
$25.69
Self Only
$34.50
$38.79
$42.42
$47.40
$51.39
Self Plus One
$51.76
$58.19
$63.63
$71.10
$77.08
Self and Family
Employed – biweekly Standard premium
Rate code 1 1
Rate code 2 1
Rate code 3 1
Rate code 4 1
Rate code 5 1
$9.53
$10.69
$11.71
$13.07
$14.15
Self Only
$19.07
$21.37
$23.37
$26.10
$28.30
Self Plus One
$28.59
$32.06
$35.06
$39.16
$42.44
Self and Family
Retired – monthly High premium
Rate code 1 1
Rate code 2 1
Rate code 3 1
Rate code 4 1
Rate code 5 1
$37.38
$42.03
$45.96
$51.35
$55.66
Self Only
$74.75
$84.05
$91.91
$102.70
$111.35
Self Plus One
$112.15
$126.08
$137.87
$154.05
$167.01
Self and Family
Retired – monthly Standard premium
Rate code 1 1
Rate code 2 1
Rate code 3 1
Rate code 4 1
Rate code 5 1
$20.65
$23.16
$25.37
$28.32
$30.66
Self Only
$41.32
$46.30
$50.64
$56.55
$61.32
Self Plus One
$61.95
$69.46
$75.96
$84.85
$91.95
Self and Family
1 Rates based on member’s primary state of residence.
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2023 GEHA dental plans
Definitions
Term
Definition
BENEFEDS is the government-authorized and U.S. Office of Personnel Management (OPM)-sponsored enrollment portal that eligible participants use to enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP). benefeds.com
BENEFEDS
Calendar year deductible
What you pay each year before the plan begins to pay out benefits.
Calendar year maximum
The maximum benefits that the plan will pay per person each calendar year.
Basic services that include preventive care such as oral exams, cleanings, diagnostic services, sealants and radiographic images.
Class A services
Intermediate services that include restorative procedures such as fillings, prefabricated stainless steel crowns, periodontal scaling, tooth extractions and denture adjustments. Major services that include endodontic services such as root canals, periodontal services such as gingivectomy, major restorative services such as crowns, oral surgery, bridges, implants and prosthodontic services such as complete dentures.
Class B services
Class C services
Class D services
Orthodontic services (braces).
Coinsurance
The percentage of covered expenses you must pay.
Any procedure or portion of a procedure performed primarily to improve physical appearance or performed for psychological purposes.
Cosmetic procedure
Any licensed dentist who is a part of GEHA’s provider network. To search for a provider, visit geha.com/Find-Care
In-network provider
The maximum benefits that the plan will pay per person. Orthodontic care on our Standard and High plans is subject to a lifetime maximum.
Lifetime maximum
The maximum amount the plan will pay for a specific procedure. The plan allowance may vary by geographic location and/or an in-network provider’s contracted fee schedule. When you use an out-of-network provider, you are responsible for the difference between the plan’s payment amount and the provider’s billed amount.
Plan allowance
The total amount paid to an insurance company for coverage, typically paid biweekly or monthly.
Premium
Visit geha.com/GetInTouch for ways to connect with a GEHA Benefits Adviser.
This is a brief description of services covered under the GEHA Connection Dental Federal plan. For a complete list of plan limitations and exclusions, please refer to the GEHA Connection Dental Federal plan brochure available online at geha.com/PlanBrochureDental
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2023 GEHA dental plans
Helpful resources
Call us Talk with a helpful GEHA Benefits Adviser. 877.590.4342
Compare plans Easily compare GEHA’s High and Standard dental plans. geha.com/CompareDental
Find a provider Find a dentist or see if yours is in-network. geha.com/Find-Care
Estimate costs See if a dental service is covered and estimate how much you will pay for those services. geha.com/DentalPricing
Check rates for 2023 geha.com/DentalRates
Get in touch Let us help you choose a GEHA plan that can work for you.
geha.com
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2023 GEHA dental plans
STANDARD US POSTAGE PAID GEHA
PO Box 21542 | Eagan, MN 55121-9930
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GEHA has a dental plan for your needs Let us help you choose a plan that can work for you.
Ready to enroll? Visit benefeds.com and follow the prompts to enroll in GEHA Connection Dental Federal. Call BENEFEDS toll-free at 877.888.3337 TTY: 877.889.5680
Download the plan brochure. For information and changes, see the official, detail-filled plan brochure at geha.com/PlanBrochureDental
geha.com | 877.590.4342
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